Natural history and postoperative evaluation of complete transposition of the great arteries

In a total of 107 cases with transposition of the great arteries (TGA-s), 20 died preoperatively and 76 underwent surgical treatment: 11 palliative and 65 primary corrective surgeries, with hospital mortality 36.4% and 46.2% respectively. Of 31 survivors after Mustard operation, tricuspid regurgitant murmur and ECG abnormalities were recognized at 26.7% and 33.3% respectively in simple TGA, and 62.5% and 37.5% respectively in complicated TGA during an average follow-up of 4 years. Angiocardiogram, performed more than 2 years postoperatively, revealed decreased ejection fraction (EF) with compensatory increase of right ventricular end-diastolic volume (RVEDV): EF 0.43 +/- 0.04, RVEDV 168 +/- 41% of normal in simple TGA and 0.36 +/- 0.12, 173 +/- 55% in complicated TGA. In 3 long-term survivors of arterial switch operation (Stansel, Kaye), no serious complications were observed, and ejection fraction and echocardiographic findings of systemic ventricle showed an earlier normalizing than in Mustard operation: EF 0.65 or more when no VSD leakage and pre-ejection period (PEP/ejection time (ET) 0.35 +/- 0.05 after switch operation, 0.45 +/- 0.05 in simple TGA and 0.47 +/- 0.07 in complicated TGA after Mustard operation. From these long-term postoperative evaluations, our policy at present is to prefer arterial switch operation to Mustard operation in corrective surgery for TGA.